BILLING NEWS

IHCP reminds providers how to interpret PA status information

As stated in BR201715, prior authorization (PA) status codes displayed on the Portal comply with the Health Insurance Portability and Accountability Act (HIPAA) 278 transaction standards and provide only a high-level, standardized description of the actual working status of the PA request. PA status information reported through the Interactive Voice Response (IVR) system is also only a high-level description. PA notification letters mailed to the provider and member, however, continue to provide the more detailed administrative working status that providers are accustomed to, and more clearly explain the current status of the PA request. The following table provides a crosswalk between the standard response categories reported on the Portal and through the IVR with the administrative working statuses associated with each standard response category. Providers should use this table to help them understand the standardized HIPAA-compliant status responses when conducting a PA inquiry. The crosswalk table below will also be available on the PA Status Code page for future reference.


INDUSTRY NEWS TAGS: Medicaid Indiana


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